| NPI | 1063820355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 18845) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18845) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 18845) | |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2024-01-02 |